Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997-2014.
Détails
Etat: Public
Version: de l'auteur⸱e
Licence: CC BY-NC 4.0
ID Serval
serval:BIB_FD500FF6DD84
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Outcome of patients admitted with acute coronary syndrome on palliative treatment: insights from the nationwide AMIS Plus Registry 1997-2014.
Périodique
Bmj Open
Collaborateur⸱rice⸱s
AMIS Plus Investigators
Contributeur⸱rice⸱s
Lessing P., Hess F., Simon R., Hangartner PJ., Hufschmid U., Hornig B., Jeger R., Trummler S., Windecker S., Rueff T., Loretan P., Roethlisberger C., Evéquoz D., Mang G., Ryser D., Müller P., Jecker R., Kistler W., Droll A., Stäuble S., Freiwald G., Schmid HP., Stauffer JC., Cook S., Bietenhard K., Roffi M., Wojtyna W., Schönenberger R., Simonin C., Waldburger R., Schmidli M., Federspiel B., Weiss EM., Marty H., Weber K., Zender H., Poepping I., Hugi A., Koltai E., Iglesias JF., Pedrazzini G., Erne P., Cuculi F., Heimes T., Jordan B., Pagnamenta A., Urban P., Feraud P., Beretta E., Stettler C., Repond F., Widmer F., Heimgartner C., Polikar R., Bassetti S., Iselin HU., Giger M., Egger P., Kaeslin T., Fischer A., Herren T., Eichhorn P., Neumeier C., Flury G., Girod G., Vogel R., Niggli B., Rickli H., Nossen J., Stoller U., Veragut UP., Bächli E., Weber A., Schmidt D., Hellermann J., Eriksson U., Fischer T., Peter M., Gasser S., Fatio R., Vogt M., Ramsay D., Bertel O., Maggiorini M., Eberli F., Christen S.
ISSN
2044-6055 (Electronic)
Statut éditorial
Publié
Date de publication
2015
Peer-reviewed
Oui
Volume
5
Numéro
3
Pages
e006218
Langue
anglais
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: epublish
Publication Status: epublish
Résumé
OBJECTIVE: Compliance with guidelines is increasingly used to benchmark the quality of hospital care, however, very little is known on patients admitted with acute coronary syndromes (ACS) and treated palliatively. This study aimed to evaluate the baseline characteristics and outcomes of these patients.
DESIGN: Prospective cohort study.
SETTING: Eighty-two Swiss hospitals enrolled patients from 1997 to 2014.
PARTICIPANTS: All patients with ACS enrolled in the AMIS Plus registry (n=45,091) were analysed according to three treatment groups: palliative treatment, defined as use of aspirin and analgesics only and no reperfusion; conservative treatment, defined as any treatment including antithrombotics or anticoagulants, heparins, P2Y12 inhibitors, GPIIb/IIIa but no pharmacological or mechanical reperfusion; and reperfusion treatment (thrombolysis and/or percutaneous coronary intervention during initial hospitalisation). The primary outcome measure was in-hospital mortality and the secondary measure was 1-year mortality.
RESULTS: Of the patients, 1485 (3.3%) were palliatively treated, 11,119 (24.7%) were conservatively treated and 32,487 (72.0%) underwent reperfusion therapy. In 1997, 6% of all patients were treated palliatively and this continuously decreased to 2% in 2013. Baseline characteristics of palliative patients differed in comparison with conservatively treated and reperfusion patients in age, gender and comorbidities (all p<0.001). These patients had more in-hospital complications such as postadmission onset of cardiogenic shock (15.6% vs 5.2%; p<0.001), stroke (1.8% vs 0.8%; p=0.001) and a higher in-hospital mortality (25.8% vs 5.6%; p<0.001).The subgroup of patients followed 1 year after discharge (n=8316) had a higher rate of reinfarction (9.2% vs 3.4%; p=0.003) and mortality (14.0% vs 3.5%; p<0.001).
CONCLUSIONS: Patients with ACS treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. While refraining from more active therapy may often constitute the most humane and appropriate approach, we think it is important to also evaluate these patients and include them in registries and outcome evaluations.
CLINICAL TRIAL NUMBER: ClinicalTrials.gov Identifier: NCT01 305 785.
DESIGN: Prospective cohort study.
SETTING: Eighty-two Swiss hospitals enrolled patients from 1997 to 2014.
PARTICIPANTS: All patients with ACS enrolled in the AMIS Plus registry (n=45,091) were analysed according to three treatment groups: palliative treatment, defined as use of aspirin and analgesics only and no reperfusion; conservative treatment, defined as any treatment including antithrombotics or anticoagulants, heparins, P2Y12 inhibitors, GPIIb/IIIa but no pharmacological or mechanical reperfusion; and reperfusion treatment (thrombolysis and/or percutaneous coronary intervention during initial hospitalisation). The primary outcome measure was in-hospital mortality and the secondary measure was 1-year mortality.
RESULTS: Of the patients, 1485 (3.3%) were palliatively treated, 11,119 (24.7%) were conservatively treated and 32,487 (72.0%) underwent reperfusion therapy. In 1997, 6% of all patients were treated palliatively and this continuously decreased to 2% in 2013. Baseline characteristics of palliative patients differed in comparison with conservatively treated and reperfusion patients in age, gender and comorbidities (all p<0.001). These patients had more in-hospital complications such as postadmission onset of cardiogenic shock (15.6% vs 5.2%; p<0.001), stroke (1.8% vs 0.8%; p=0.001) and a higher in-hospital mortality (25.8% vs 5.6%; p<0.001).The subgroup of patients followed 1 year after discharge (n=8316) had a higher rate of reinfarction (9.2% vs 3.4%; p=0.003) and mortality (14.0% vs 3.5%; p<0.001).
CONCLUSIONS: Patients with ACS treated palliatively were older, sicker, with more heart failure at admission and very high in-hospital mortality. While refraining from more active therapy may often constitute the most humane and appropriate approach, we think it is important to also evaluate these patients and include them in registries and outcome evaluations.
CLINICAL TRIAL NUMBER: ClinicalTrials.gov Identifier: NCT01 305 785.
Mots-clé
Acute Coronary Syndrome/complications, Acute Coronary Syndrome/mortality, Age Factors, Aged, Aged, 80 and over, Angioplasty, Balloon, Coronary, Anticoagulants/therapeutic use, Cohort Studies, Female, Heart Failure/etiology, Heart Failure/mortality, Heparin/therapeutic use, Hospital Mortality, Humans, Male, Middle Aged, Myocardial Infarction/epidemiology, Myocardial Infarction/etiology, Palliative Care/methods, Platelet Glycoprotein GPIIb-IIIa Complex/therapeutic use, Prevalence, Purinergic P2Y Receptor Antagonists/therapeutic use, Registries, Shock, Cardiogenic/epidemiology, Shock, Cardiogenic/etiology, Switzerland/epidemiology, Thrombolytic Therapy, Treatment Outcome
Pubmed
Open Access
Oui
Création de la notice
02/02/2016 16:26
Dernière modification de la notice
30/03/2023 5:54
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